Figure 1: A- Pre-thrombolysis B– Post-thrombolysis
Transthoracic echocardiography (TTE) revealed akinetic base to mid
inferior,
inferolateral and lateral walls. Left ventricular ejection fraction
(LVEF) was
visually estimated to be 45%. Mild functional mitral regurgitation with
insignificant pulmonary hypertension. Normal right ventricular systolic
function.
His further stay was uneventful with no symptoms of angina, shortness of
breath and constitutional symptoms. He was ambulated from second day
onwards.
On 5th day he developed severe acute chest pain with
diaphoresis. His
recorded blood pressure was 70 mmhg systolic, heart rate of 145/minute
and
pulse oximetry saturation 70% on room air. On auscultation, He did not
have
any audible murmur but had extensive rales extending till mid-zones of
both
lung fields. ECG revealed STE in leads II, III and AVF with reciprocal
changes
anteriorly (figure3) suggesting inferior wall re-infarction.